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Research Reports |
L Foord-May, PT, PhD, Director of Department of Online Teaching and Learning, School for Health Studies, Simmons College, 300 The Fenway, Boston, MA 02115-5820 (USA)
(foord{at}simmons.edu)
Submitted February 7, 2005;
Accepted August 1, 2005
 | Abstract |
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Subjects and Methods. Face-to-face, semistructured interviews followed by a focus group were conducted with 7 faculty members, guided by questions about factors that influenced instructors’ experience of changing instructional methods.
Results. Nine themes described the faculty’s experience: perception of need for teaching change, personal knowledge of problem-based learning, decision-making process, peer support, partial adoption, values related to teaching and learning, significant response from the community, administrative support, and perceived barriers to incorporation of problem-based methods.
Discussion and Conclusion. The findings are consistent with literature describing change: change is a process, the process of change must accommodate individual change, a network of peer support is necessary, and the change process requires leadership and support from administrators within and outside of the group. [Foord-May L. A faculty’s experience in changing instructional methods in a professional physical therapist education program.
Key Words: Education: faculty • Education: physical therapist students • Education: problem-based learning
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The need for this level of performance of new graduates raises the question of whether traditional methods of instruction can effectively prepare students for the current practice environment. Traditional lecture-based instructional methods that are familiar to current physical therapist faculty may not be sufficient to educate current students for the practice environment that they will face. If new graduates are expected to be independent shortly after graduating, those who educate them must implement the instruction that is necessary to effectively prepare their students for clinical practice. Thus, it may be necessary for physical therapist educators to incorporate new and different methods of instruction.
In response to the demands of a changing practice environment, many physical therapist educators have incorporated problem-based instructional methods into their teaching.6–8 Faculty in some medical programs and nursing programs have made similar decisions.1,3,9–13 Problem-based learning (PBL) uses authentic clinical problems to address educational objectives. Problem-based learning began in the McMaster University medical program in 1965 in response to the rapid growth in information and technology. Proponents of the problem-based approach expect that students will demonstrate increased retention of information and an improvement in their ability to apply information in clinical contexts. It also is anticipated that students learning in a problem-based environment will practice and develop skills of lifelong learning.3,7,10,14,15
Students are presented with problems to be solved and opportunities to acquire the information necessary to understand and solve the problems. A hallmark of PBL has been the use of small-group tutorials, in which students solve problems with the guidance of a tutor who is expert in the discipline.14 This method of instruction is attractive to educators because the mode of learning mirrors actual clinical practice.8,10–12,14–16 The use of authentic cases in problem-based instruction teaches students to structure their learning and organize information in ways that will be most useful to them in clinical practice.3,7 The cases are designed to incorporate the complexity and ambiguity found in practice and to introduce students to the multidisciplinary collaboration that will be expected of them.14
Problem-based learning requires a change in the role of the instructor and a focus on different instructional skills than are required in traditional lecture-based instruction.7,14,17,18 Those who support PBL strongly urge that all faculty members who will participate complete training in the tutorial method.7,9,10,17,18 Workshops offered by experts in problem-based instruction include training in skills of questioning, active listening, and guiding students’ learning.7,9,14,17 To be successful as a tutor requires that the instructor shift roles from the authoritarian content expert ("sage on the stage") to the facilitator of self-directed learning ("guide on the side").14,17 This is a significant paradigm shift for many instructors, which requires not only that they change the way they teach but also that they change the way they think about themselves as instructors and how they perceive their students as learners.9,14 Although there is sufficient literature to describe the content, process, and success of workshops to train instructors in problem-based methods,14,17,19 less is known about the actual process of change experienced by instructors who transition from traditional methods of instruction to incorporate problem-based methods.
The general process of change as put forward by Rogers20 begins with potential adopters assessing the relative advantage of the innovation, that is, the perceived compatibility of the innovation with individual values and those practices that currently exist in the organization. Potential adopters will next consider the complexity of the innovation, particularly whether specialized training will be required to implement the change and what, if any, risks are associated with implementation. Particularly for complex innovations, potential adopters will want to know whether the innovation has "trialability," that is, the potential to be implemented in parts or stages. Trialability is a mixed advantage; it may facilitate adoption if only a part of the innovation is adopted. However, when the innovation is only partially implemented, it may be easier for the players to revert to prior practices. Another factor that can influence change is how easily the innovation can be observed, communicated, or described to others. Finally, all potential adopters will want to know whether a single individual can adopt the innovation or whether all members of the social system will need to comply in order to adopt it. Related research21 showed that even if a single player can adopt the innovation, the chances of maintaining the change are greatly increased if the entire social system is involved in the change, so that members can provide support and encouragement for one another. Rogers20 also described how the characteristics of the group that is considering adoption, as well as the social system into which the change is introduced, can influence the ultimate success or failure of the change process.
To understand how instructional change occurs in higher education, it is necessary to examine change at the level of the individual, because it is the individual instructors who ultimately instruct the students.22 Any study of change in the academic setting must also consider the culture of the group into which the change will be introduced, as well as the process of change at the organizational level.23 Even the most passionate and committed individual or small group cannot prolong change indefinitely without support from the organization.21
To ensure that the education of future clinicians effectively supports the profession, it is, in my opinion, necessary for physical therapist education programs to manage change. Effective management of educational change requires transitions by individual instructors.22 Thus, it may be in the best interest of the profession to understand how a change in instructional methods is perceived by the instructors themselves. The purpose of this study was to describe a physical therapist program faculty’s experience and process in transitioning from traditional instructional methods to PBL instructional methods. Specifically, the faculty were asked to recall the process of change, the factors that affected their decision to change, the factors related to their ability to sustain the change, and how the group influenced the change process.
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Participants
The sample for this study was selected using purposeful sampling, a common form of nonprobability sampling, which requires that the sample be intentionally selected to provide information that will contribute to the theory.25,26 The participants in this study, identified by pseudonyms, were a group of 7 faculty members in a physical therapist education program who worked together over a period of approximately 12 years, beginning in the early 1990s as the curriculum evolved from a traditional approach to a problem-based approach to instruction. None of the participants taught at another institution during the transition (Tab. 1).
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In the course of the change process, the faculty in the program identified the need for change, learned about PBL as a potential innovation, and decided that the method was compatible with their formal beliefs about teaching. They developed a support system within their group and successfully enlarged it to include members of the clinical community (Tab. 2).
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Each participant signed a consent form. Faculty were interviewed in their office, and each interview was scheduled for 1 hour. Each participant was asked a series of open-ended questions that allowed the participant considerable range in her responses (Appendix). The follow-up questions used to augment responses to the broader questions utilized cues suggested in the literature27–29 to facilitate further recall: encouragement to organize events into a sequence and specific nouns to stimulate the recall of events. All except one of the participants also participated in a focus group conducted after the completion of all individual interviews to discuss the change process and compare experiences. The questions used in the focus group were similar to those used in the individual interviews to allow comparison of the group’s recollection with the story told by each participant. The discussion in the focus group also was audiotaped and professionally transcribed. Throughout the individual interviews as well as the focus group, the investigator occasionally took notes. Following the interviews and focus group, each participant had the opportunity to read through the transcript of her individual interview as well as the focus group and return corrections, clarifications, and comments to the researcher.
In addition to the data collected during interviews and the focus group, one further data source was used to triangulate the data collected in this study. Each faculty member was asked to submit the syllabus for a course currently being taught. The syllabi were analyzed to record the integration of problem-based instructional methods. Data from the document analysis was used to confirm the information contained in the interviews and focus groups describing changes in teaching behaviors, but added little to the description of the experience of change.
Data Analysis
The typed transcriptions were analyzed using the constant-comparative method. In this method, the researcher is constantly comparing newly collected data with existing data and making modifications to clarify the emerging categories. The outcome is a theory that is grounded in the data and has been thoroughly refined through the course of the analysis.25
In this study, I read through each transcript entirely, underlining or highlighting important words and ideas. In the second reading, categories of responses were created, named, and recorded as descriptive themes for use in subsequent transcript analyses. After all transcripts had been analyzed once, including the transcript of the focus group, the descriptive themes were revised and collapsed, and the transcripts were analyzed a second time to ensure consistency in the analysis and to assess the viability of the descriptive themes.
Throughout the interviewing and analysis process, I wrote formal memos. As defined by Glaser, "A memo is the theorizing write-up of ideas about codes and their relationships as they strike the analyst while coding ... it can be a sentence, a paragraph or a few pages."30(pp83–84) Following each interview, I used the Contact Summary Form proposed by Miles and Huberman.31 A Contact Summary Form is "a single sheet with some focusing or summarizing questions about a particular field contact."31(p51) These memos included my observations, insights, and theories about the data that emerged at each stage of the analysis. Memoing contributed to the process of creating and refining the themes that described the participants’ experience of change and helped me to organize central concepts into a logical story that accurately reflected the data from which the themes and participants’ stories emerged. Lastly, an audit trail of the data analysis was conducted by an experienced qualitative researcher who periodically reviewed my process of analysis to ensure that it was logical and consistent.
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In this case, the change process was initiated by one instructor who found her current methods of teaching to be inadequate:
Anna: I thought my previous method of teaching was boring. ... I didn’t ever get the sense it was ineffective in a way that was any different from anyone else teaching in that way, but I never got the sense that students really felt excited or engaged.
Another instructor described similar feelings:
Carla: I think one factor was looking at this traditional form of delivery and being kind of bored with it and not thinking it was particularly effective for what our students needed to learn that would be relevant in the clinic.
While Anna initiated the proposal for change and led the change process, other instructors also acknowledged a gap in the effectiveness of their teaching. In this case, the perception by several individuals on the faculty of the need for a teaching change created a recognition of the need for new instructional methods in order to improve the effectiveness of the program’s instruction.
Personal Knowledge of PBL
Rogers20 and Evans33 described that the characteristics of the innovation are central to the process of change. Potential adopters of an innovation must see it as compatible with their own individual values as well as with the values of the organization. Adoption of the innovation also must predict an outcome that is sufficiently valuable to offset the time, risk, and effort required to change.
Anna had learned about PBL at a workshop and found in it "what I was always trying to do and didn’t know how to do it." She had always believed that the ability to apply information was the key to being an excellent clinician, and the problem-based approach seemed to be an effective way for students to learn application.
Anna: I didn’t know what to call it. I didn’t know that one could even do it, and then that’s when I started thinking, well, I think that’s how my PT [physical therapy] program was in a way. So it was an old experience that I had found that fit me, and so then I just came back, and I was like this born-again problem-based learning person, and I just felt like everyone should do this. We have to try it. So that’s kind of how I got going.
Other faculty members, Carla and Ginger, found problem-based methods to be consistent with the problem-solving process they had used as clinicians.
Ginger: I knew I wouldn’t have had any problem with it, because it sounded to me much more the ... way I traditionally think when I’m in the clinic. ... In some ways, it was an easy process for me to get used to because it’s in many ways the way I think when I’m trying to go about treating a patient and going through that problem-solving technique.
Darla, who had initially resisted the change, became a strong supporter once she was able to identify elements of problem-based instruction that accomplished the goals that she held to be her responsibility as a teacher. Ultimately, she also noted similarities to her experiences as a clinical instructor:
Darla: I think one of my favorite things is developing that kind of relationship with students and then seeing the students learn. I had never seen a student learn except maybe when I was in the clinic. You don’t see learning in a traditional classroom—that did it. Just seeing one student actually get it on the spot. It was great. So as soon as I saw that, I was hooked.
Prochaska and DiClemente’s transtheoretical theory of personal change34 predicts that when an individual becomes aware of the need for change, he or she enters a stage of contemplation and begins to seek out opportunities to talk about new understandings and anxieties about the prospect of change. This process of self-reflection and re-evaluation is necessary preparation for the decision to change. As the individuals in this faculty group began to contemplate the concept of changing instructional methods, they engaged in group discussions identifying the challenges and advantages of incorporating problem-based methods into the curriculum. One outcome of these discussions was an awareness of the importance of faculty development activities as part of the change process to provide opportunities for each instructor to learn about how she might incorporate problem-based instructional methods into her course design and her teaching. The combination of individual reflection, group support, and education about the innovation were pivotal elements leading to each individual’s decision to change instructional methods.20,34–36
Decision-Making Process
If an individual faculty member were to decide to change instructional methods, she would have to find that the innovative methods were consistent with her formal, informal, and technical beliefs about teaching. Formal beliefs are values that are simply accepted without question; in fact, many individuals may be unaware of their formal beliefs. Informal beliefs are those that are learned as part of the socialization process, so they are more apparent to the individual than formal beliefs and are often easier to change. Technical beliefs are most amenable to change; they reflect behaviors that have been learned through formal instruction.37
The formal beliefs of each instructor were expressed in the goals she described for herself as an educator in preparing her students with the knowledge, skills, and behaviors that would make them successful in the clinic. In making the decision to change, these instructors had to determine that problem-based instructional methods were consistent with their formal beliefs about teaching and believe that innovative teaching methods could improve their ability to meet their professional duty as instructors.
Carla: Problem-based learning was a way to incorporate things that happened in the clinic to the classroom. So there was more of a connect there between classroom issues and clinical issues. ... I think it does [resemble the way a CI (clinical instructor) teaches in the clinic] because in the clinic you were constantly looking at a new problem and working through what you knew, what you might not have known, what you need to research more and then strategizing about how you were going to deal with that problem. You do the same thing in tutorial. I really thought that [this method of instruction] would enhance the way that students learned and better prepare them for the way they learned in the clinic, so I was really enthusiastic about transitioning [my] course and moving it away from a traditional lecture format.
Ginger described her reasons for making the change:
My specialty is [teaching] in the clinic and figuring out what to do with [each patient]. I love it [PBL] because it’s a much more hands-on and practical approach that gets down to the issues rather than the simple facts that are found in traditional books.
Peer Support
Each individual made her own decision to change instructional methods. However, the support of the group was necessary to generate sufficient momentum to make sufficient change and sustain the evolution of instructional methods.22,36 Multiple sources recognize that the support of the group is essential for the successful implementation of an innovation.19,20,38–40 In the early stages of the change process, the support came from the small group of instructors who initiated the change process led by Anna.
Barbara: I think we all agreed to do it. I have to say that. Anna was obviously very instrumental in this because she ... had gone to a workshop and come back extremely enthusiastic about it, and I think we all felt that it would be a good way to start out the students from the beginning applying information and also being more self-directed because we were handling a lot of information. We were all very enthusiastic and saying and thinking that this would be a good way of teaching.
As the change process progressed, and problem-based methods were incorporated into more courses in the curriculum, it was necessary to gain support from a larger group of peers to include practicing clinicians. The clinicians would provide the link with current clinical practice that is central to the problem-based approach.
Barbara: We had several meetings with clinicians in the area and got their feedback, which was great. It was very nice to have that contact with them ... designing those cases so that they would work well ... using those cases for the basis of your labs ... [determining] the basic kind of sequencing nature of the cases, and the information that you’re hoping people are going to come away with.
Support from within the faculty group as well as support from members of the clinical community assured faculty of the compatibility of the innovation with individual values as well as the values of the organization.20 In his work on group dynamics theory, Cartwright21 has shown that the chances of maintaining change within a group or culture are greatly increased if the entire social system is involved in the change, so that members can provide support and encouragement for one another.
As the faculty moved through the process of changing instructional methods, they developed a support system within their group and successfully enlarged it to include members of the clinical community (Tab. 2). Another factor that would contribute to the acceptance of the innovation was for each individual to learn whether she really believed that she could incorporate problem-based instructional methods into her teaching.
Partial Adoption
Rogers20 contended that trialability, or the ability to partially adopt the innovation, is directly related to the successful implementation of an innovation. Potential adopters need to learn whether the foundational theory of an innovation can be flexible enough to allow selective components of the innovation to be partially adopted in the initial stages of the change process.
Trialability was a key to the successful implementation of problem-based instructional methods in this case. For example, although Darla was initially hesitant to change her methods of teaching, once she came to see that problem-based methods could be implemented differently by different instructors, she became an enthusiastic participant.
Darla: I was trying to figure what are the rules and how do I follow them [to incorporate PBL]. I did go to [another faculty member’s] tutorial and saw she didn’t follow the rules at all. My mouth dropped. I couldn’t believe it. I thought, I have my own personality. I know what is going to work for my students. I’ll honor the big picture, but I’ll do what I need for them to get the outcome that we want, which is lifelong learning, the ability to learn independently, and professional social skills.
Ella chose to incorporate traditional evaluation methods instead of the assessment techniques espoused by pure PBL theory in order to accomplish her goal of preparing students to be successful on the licensure examination and to be prepared for the time limitations found in clinical practice.
Ella: I actually do go out of my way to make multiple-choice exams in my courses that are similar to the way the board exams will be, and on their practical exams I force them to get it done in a certain amount of time.
Fiona created new ways of integrating problem-based methods to link nonclinical research courses with clinically based courses that the students were taking concurrently.
Fiona: Teaching a traditional math-based course [makes it] a bit harder to think of creative ways of applying PBL than it would be for [a clinical course]. So I present a question, a research question: "Pretend that during the clinic today we saw a patient who’s interesting. Here’s what we might want to do." And we base [the discussion] on that. Or I introduce a concept and then, in ... the subsequent session, either I have an article that students read and [use] tutorial format questions to start the dialogue going or I set up exercises outside of an article. ... I think I allowed students more of an opportunity to present ideas first and comment on them only when it looks like they’re having some issues or when other students can’t help them out, where normally I would just jump in and give the answer.
The ability to be both selective and creative in the adoption of problem-based methods made it easier for each of the participants to implement the innovation and sustain the process of change within the group. In looking back at the process of change, all of the participants agreed that part of the reason that they were able to support the use of problem-based methods was because it was acceptable to implement only those components that meet the identified needs for their students.
Values Related to Teaching and Learning
Once they had begun to incorporate new instructional methods, the momentum of the change process was sustained as the instructors learned that the new methods were providing results that were consistent with their values about teaching and learning.
Ella found problem-based instruction to be personally and professionally rewarding in promoting skills she values in professional practice:
I would say that, as a teacher, it’s very rewarding to see people learn and to be able to do things on their own, that you facilitated their learning as opposed to just having them memorize and say, well, Ella said, so I’m going to do it Ella’s way because Ella thinks this not that. It’s much more; it’s like that proverb, you can teach someone how to fish and they can fish for a lifetime versus feed them for a day. I find that very rewarding and exciting to watch them grow and be successful.
Carla observed problem-based instruction to be more effective in preparing the students to transition to the clinic:
We found that the students were learning so much more through the problem-based learning process versus straight lecture format. They were also learning cutting-edge information about whatever patient problems they were researching. They were more [in-depth] in their discussions, and I found that the students learned from each other as well. They went into great depth on different issues of patient problems ... in addition to that, if they don’t know ... something, they know where to find it. ... We just found that it was incredibly helpful for them in the transition to the clinic.
Anna found that problem-based methods supported her value of facilitating students in developing attributes of a professional in addition to a foundation of knowledge and skills:
I can actually know how students are learning and what they’re learning or not learning. I feel I have a better influence. ... I can talk to them about behaviors that I think will help them as professionals: speaking up, looking at people, sitting up straight ... things like that that in a big classroom you’d never address. I think I can help them in more ways. ... The other thing I think is that they learn to communicate with one another and they learn teaching skills. ... They’re learning many more skills than you can learn from just listening to someone lecture at you, and you would never be able to convince me that those things that are important would ever happen in another environment.
Implementation of problem-based instructional methods by individual instructors was driven by their experience that the new instructional methods were personally and professionally rewarding, prepared students more effectively for the clinic, and allowed faculty to teach "the whole student" rather than simply transmit information. However, health care professions education is complex because it has numerous clients, including students, current practitioners, and patients. No matter how personally rewarding a theory might be, unless it can be shown that the students will be well received in the clinical practice setting, change in instructional methods in health care professions education is not likely to occur.
Significant Response From the Community
Support for the initial change had come both from within the faculty group and from the larger culture of clinical practitioners. This larger network of support is important for sustaining the change process.21,35,36
Participants in this study noted that the positive responses from their students, and the feedback from their clinical colleagues confirmed the teaching and learning values that they had observed in the academic stetting. Carla observed that, even before they reached the clinic, students were learning firsthand about individual differences in practice and the kinds of clinical decisions that needed to be made in practice:
Carla: The students love it. It really helps them in tutorial because then they get feedback from people who are out in the field about [whether] they like or don’t like certain procedures [and] the advantages and disadvantages of certain procedures.
Ella was encouraged by positive feedback she received from students in clinical placements as well as from graduates of the program as they reflected on their learning experiences with PBL:
The most rewarding part, really, is when you talk to our alumni or you talk to our students who are on clinical affiliations, and they feel confident, they feel like they know where they need to go to be resourceful, and the feedback that you get from the clinicians, how amazing the students are, and how they stand apart from everybody else because they are so self directed, they know where they need to go, where to find something. I’m not sure they [the students] appreciate it fully when they are here because they haven’t had an opportunity to really show it off in the real world or to use it, but that’s where it really makes sense.
As a group, the faculty participants agreed that preparing students for clinical practice is the primary goal of health care professions faculty. Based on feedback from tutors, clinical instructors, students, and alumni, it was their perception that problem-based methods were effective in achieving that goal and, therefore, that PBL was an innovation that should be preserved.
Barriers to the Use of PBL
Although the instructors eventually came to strongly support problem-based instruction, it is clear that, throughout the process, there were barriers to incorporating problem-based methods of instruction. The theory and teaching methods constitute a significant change from traditional instructional methods of lecture and demonstration.7,10,14,15,18 For some instructors, the challenge was personal; others were confronted with how to resolve conflicts between the theory behind problem-based instruction and the values of the curriculum.
Darla provides a rich example of the personal challenge of overcoming conflict between the values of the instructor and the theory and practice of the innovation. At the outset of the change process, Darla "had no interest in changing ... none whatsoever." Furthermore, although she participated in group discussions about incorporating problem-based methods and engaged in faculty development activities, she felt unprepared to implement problem-based methods and still achieve her expectations for herself as a teacher.
Darla: I felt as though I didn’t have a clue of how to teach without talking. I’m going to get people to do all these high-level skills, and I’m not going to tell them how to do it. I couldn’t figure it out. I knew how to do it for them, and I knew how to tell them to do it, but I didn’t know how to get them to a higher level without saying very frankly, this is what you should do.
Darla was able to overcome this barrier; however, she needed time to change at her own rate. She needed to develop knowledge about PBL that allowed her to find common ground with her formal values about teaching. Faculty development activities helped her to learn about PBL, and, after observing an actual tutorial, she was able to learn how to incorporate her values with the innovative methods. Ultimately, she gained the experience that she needed to overcome her hesitation.
Barbara fully engaged in the process of changing instructional methods; however, she still held some reservations about the ability of problem-based methods to provide the foundational information students require to be safe and effective in the clinic and to pass the licensure exam.
Barbara: I don’t know if "concerned" is the right word ... [about] the different tacks that tutorials take in terms of the information. ... I still question ... because this is a major part of where the students get their content and [for the] clinic you have to take a professional exam.
In response to her concern, Barbara developed "tutor guides" to ensure that students in different tutorial groups all addressed all of the requisite course objectives.
Ella had learned in her faculty development activities that pure problem-based curriculum does not limit students’ time in lab. Knowing that efficient time management is essential for effective clinical practice, she did not believe that this element of problem-based instruction would effectively prepare students for the clinic, so she imposed time limits on her practical examinations. She also had learned that the theory of PBL does not support multiple-choice–style testing. However, the physical therapy licensure examination is a timed, multiple-choice examination, and she believed that students benefit from practice in applying physical therapy–related information to multiple-choice questions. In response to this conflict between the theory of the innovation and the goal of the curriculum, Ella incorporated traditional testing methods into her courses to ensure that all examinations included multiple-choice questions as well as short-answer and essay questions.
Administrative Support
Instructors had different perceptions of barriers presented by the change to problem-based instructional methods, and each instructor dealt with her reservations in her own way. Yet, all instructors agreed that, without support from the administration, the change process would not have occurred. The literature on academic change strongly supports the value of administrative support in promoting effective change.23,41 In this case, 2 types of administrative support were crucial in promoting and sustaining the process of change.
Administrative support from within the faculty group was provided by Anna as the leader of the change process. Shortly after proposing the integration of problem-based methods, Anna implemented problem-based methods in her own courses and both encouraged and collaborated with her colleagues to do the same. When Anna took on the role of program director, she made PBL a philosophical base for the program. Faculty members were provided with education about PBL and training in its instructional methods.
Anna: Well, after I was being pushy about it, we actually had someone come from McMaster [University] and give the whole school a workshop, and I think we did a day and a half ... and then we had some training sessions for tutors ... engaging people within the community.
This common experience created a supportive network within the faculty, and in the larger community, that facilitated the integration of innovative instructional methods. As new faculty members were hired, Anna made sure that they understood that problem-based instruction was a requirement of the position. Eventually, each course in the curriculum was revised and redesigned to incorporate problem-based instructional methods.
The second element of administrative support was the role taken by the dean, first in providing resources and second in providing the expectation of change.
Barbara: I think the administration has always been excited by this approach. [The dean] was so supportive and involved with it, and I think it’s kind of a hallmark of a program that the administration likes to talk about. They can get really nice feedback from clinicians about our students’ independence, ability to think, and ability to problem solve, which are all the things we want in our students. People in charge really supported it ... really supported it, and they supported it financially because it takes more resources, way more.
The dean made sure that sufficient funds were available for faculty development, a pivotal element of successful change. Furthermore, the dean herself acted as tutor in some of the first courses to be redesigned, demonstrating her support of the change and reinforcing her expectation that faculty would take part in the change process.
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The second assumption is that the process of instructional change involves changes on the part of individual faculty22 and requires consideration of that individual’s readiness for change and the factors that stimulated and motivated his or her personal change.34,35 Each instructor who participated in this study described a different process of change. For example, Anna and Ginger adopted problem-based techniques very quickly, whereas Darla needed time to align problem-based instruction with her values about teaching. Both Barbara and Ella deviated from pure problem-based theory to combine more traditional methods they believed strengthened the educational experience of the students. However, the stories of these instructors also show that factors such as familiarity with PBL, knowledge about PBL, and peer support influenced each individual’s readiness to change and helped to drive her progress in incorporating problem-based methods into her instruction.
The third assumption is that the change process is most successful when the innovators have the support of their cultural group.21,36 In this study, the individual participants worked together as a group to create and sustain the change. They first formed an internal network of support among the academic faculty. As the process of change proceeded, they extended that network to include clinical colleagues.
The fourth assumption is that the change process requires support from both outside and within the organization.20,41 Anna’s actions initiated the change; when she became program director, she acquired the authority to provide resources such as faculty development, which sustained the momentum for change. The process of change was further supported by financial resources provided by the dean, who also reinforced the expectation of change within the program.
Limitations of the study include the collection of data by self-report, which although providing a rich personal view of the change process, also carries both limitations and biases. In addition, I was asking the participants to recall events that may have occurred up to 12 years ago, so some dispersal of the actual facts must be acknowledged. The interview process, however, was designed using accepted procedures to promote recall of autobiographical facts from long-term memory.27–29 Finally, the sample was small, even for a qualitative study. However, focusing on a cohesive group of faculty who have worked together for several years has provided a valuable insight into the group dynamics that influenced the process of their change to the problem-based approach.
Implications for Further Research
To learn more about the change process in higher education, it may be useful to extend this work in one or more directions. By applying the methodology used in this study to other groups that have incorporated problem-based instruction, comparison research could reveal more about the process of making this particular type of change in instructional methods. Researchers also could conduct a longitudinal study that could chronicle the changes over time and provide an even richer understanding of the individual perceptions of the change process.
Knowledge about change in higher education could be expanded by studying other types of curricular change. For example, a wide variety of instructional technologies are currently being incorporated into physical therapy education; an examination of the similarities between that process of change and the process described in this study could add to the understanding of the change process in higher education.
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| Footnotes |
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This research was given as a platform presentation at the Annual Conference and Scientific Exposition of the American Physical Therapy Association; June 8–11, 2005; Boston, Mass.
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